Complete Health Indicator Report of Suicide Mortality Rate - All Ages

Definition

The age-adjusted rate of deaths resulting from the intentional use of force against oneself. Suicides are reported as the number of resident deaths resulting from the intentional use of force against oneself per 100,000 population (age-adjusted to the 2000 standard population). The definition of suicide is "death arising from an act inflicted upon oneself with the intent to kill oneself." ICD-9 codes: E950-E959. ICD-10 codes: *U03, X60-X84, Y87.0.

Numerator

Number of deaths in a population resulting from self-injurious behavior with an intent to die as a result of the behavior for a specified time period.

Denominator

Mid-year resident population estimate for a specified time period.

Data Interpretation Issues

[http://live.laborstats.alaska.gov/pop/index.cfm Alaska population estimates] provided by the State Demographer in the [http://laborstats.alaska.gov/ Research and Analysis Section] of the [http://labor.alaska.gov/ Alaska Department of Labor and Workforce Development].

Why Is This Important?

The rate of suicide is increasing in America. Suicide rates have risen nearly 30% between 1999 and 2016. ^1^ In 2016, suicide was the 10th leading cause of death.^2^ Suicide claims more lives than traffic accidents and more than twice the number of lives claimed by homicide.^3^ Leading methods of suicide are discharge of firearms, suffocation, poisoning and falling.^4^
The economic and human cost of suicidal behavior to individuals, families, communities, and society makes suicide a serious public health problem. Alaska had the second highest age-adjusted suicide rate in the nation in 2016, the most recent year for which national data are currently available.^5^
Suicide cost Alaska a total of $249,000,000 of combined lifetime medical and work lost cost in 2014, or an average of $1,491,017 per suicide death.^6^[[br]]
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1. Stone DM, Simon TR, Fowler KA, Kegler SR, et al. Vital signs: trends in state suicide rates - United States, 1999-2016 and circumstances contributing to suicide - 27 States, 2015. MMWR Centers for Disease Control and Prevention. June 8, 2018;67(22):617-624. [https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722al_x]. Accessed June 8, 2018.
2. Kochanek KD, Murphy SL, Xu J, Arias E. Mortality in the United States, 2016. NCHS Data Brief. December 2017;293:1-8. [https://www.cdc.gov/nchs/data/databriefs/db293.pdf]. Accessed June 14, 2018.
3. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016.
4. Shain B. Suicide and suicide attempts in adolescents. Pediatrics. American Academy of Pediatrics, Committee on Adolescence, Clinical Report. July 2016;138(1):e1-12. [http://pediatrics.aappublications.org/content/early/2016/06/24/peds.2016-1420]. Accessed August 28, 2018.
5. U.S. Centers for Disease Control and Prevention (CDC). Suicide mortality by state: 2016. [https://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm]. Accessed October 1, 2018.
6. Luo F, Florence C. State-Level Lifetime Medical and Work-Loss Costs of Fatal Injuries - United States, 2014. MMWR Morb Mortal Wkly Rep 2017; 66: 1-11. [https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6601a1.pdf]. Accessed December 10, 2018.
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How Are We Doing?

Alaska had the second highest age-adjusted suicide rate in the nation in 2016 at 25.3 deaths per 100,000.^7^ In 2017 the suicide rate among all Alaskans was 26.9 deaths per 100,000; the rate among Alaska Native people was nearly double at 51.9 deaths per 100,000.
Suicide claimed the lives of 197 Alaskans in 2017 (156 males and 41 females), age adjusted rates have risen by 19% since 2007. Firearms were the leading mechanism of death by suicide, making up 59.9 percent of all suicide deaths in 2017.^8^
Alaska's suicide rates continued to be the highest among males, young adults (15-24 year olds), American Indian/Alaska Native people, and persons living in the rural regions of the state. Residents in Northern and Southwest Alaska are at significantly higher risk for suicide.
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7. U.S. Centers for Disease Control and Prevention (CDC). Suicide mortality by state: 2016.
[https://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm]. Accessed October 1, 2018.
8. Health Analytics and Vital Records Section, Alaska Division of Public Health. Alaska vital statistics 2017 annual report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2017.pdf]. Accessed January 4, 2019.
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How Do We Compare With the U.S.?

In 2016 (the most recent year for which national data are available), the national suicide rate was 13.5 deaths per 100,000. The suicide rate in the U.S. has been increasing since 2000, when the rate was 10.4 per 100,000. The rate of suicide among all Alaskans in 2016, 25.3 per 100,000, was nearly 2 times higher than the national rate. For Alaska Native people in 2016, the rate was more than 3 times higher than the national rate, 43.5 per 100,000.[[br]]

What Is Being Done?

The Statewide Suicide Prevention Council [http://dhss.alaska.gov/suicideprevention/Pages/default.aspx ] advises the governor and legislature on issues relating to suicide. In collaboration with communities, faith-based organizations, and public-private entities, the Council works to improve the health and wellness of Alaskans by reducing suicide and its effect on individuals and communities.
A comprehensive state plan addressing goals and strategies to prevent suicide developed by the council can be found at: [https://www.sprc.org/sites/default/files/Recasting-the-Net-Promoting-Wellness-to-Prevention-Suicide-2018-2022.pdf].

Evidence-based Practices

Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs. Below are the strategies identified for enhancing mental health support systems.
'''Strategy 1:'''
[[br]]Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities (universal prevention).
'''Evidence Base:'''
[[br]]The World Health Organization holds that "a supportive environment is of paramount importance for health. The two are interdependent and inseparable" (Sundsvall Statement on Supportive Environments for Health, 1991). Supportive environments can help protect people from risk factors for poor health, encourage participation in health care and health promotion, expand individuals' health competencies and self-reliance, and support person-centered health care. Stigma and attitudes about help-seeking (specifically seeking treatment or services for mental health conditions) are key barriers to promoting mental and emotional health and preventing mental illness. Creating communities that de-stigmatize depression and mental illness and encourage people to seek mental health services when needed can increase the number of people accessing services.
'''Sources:'''
[[br]]Segal DL, Coolidge FL, Mincic MS, O'Riley A. Beliefs about mental illness and willingness to seek help: a cross-sectional study. Aging Ment Health 2005;9(4):363-7.
Reynders A, Kerkhof AJFM, Molenberghs G, Van Audenhove C. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry and Psychiatric Epidemiology 2014;49(2): 231-9.
'''Strategy 2:'''
[[br]]Enhance clinical and community preventive services to ensure availability of timely treatment and support services (indicated prevention).
'''Evidence Base:'''
[[br]]Nearly half of individuals who die by suicide had a diagnosable mental health disorder. Timely access to appropriate mental health and substance use disorder treatment services as close to home as possible is essential to preventing suicide. Not all behavioral health professions provide or require suicide-specific education for licensure. Yet, outpatient and community behavioral health providers often provide services to individuals at risk of suicide and so are in a position to help prevent suicide. Evidence-based training that strengthens clinical competencies to address suicide risk and ideation can reduce suicide among people receiving behavioral health services.
Primary and specialty health care providers also have a role to play in suicide prevention. Appropriate assessment and referral for services is needed in a variety of health care settings. Integrating behavioral health care with primary care can help ensure timely access to appropriate services, especially for patients experiencing mental health disorders. For example, the Community Preventive Services Task Force, DHHS recommends collaborative care for the management of depressive disorders.
'''Sources:'''
[[br]]National Research Council. Reducing Suicide: A National Imperative. Washington, DC: The National Academies Press, 2002.
Recommendation from the Community Preventive Services Task Force for Use of Collaborative Care for the Management of Depressive Disorders[http://www.thecommunityguide.org/mentalhealth/CollabCare_Recommendation.pdf]
'''Strategy 3:'''
[[br]]Allocate resources to suicide prevention efforts proven effective through evidence based on surveillance, research, and evaluation.
'''Evidence Base:'''
[[br]]Prioritizing funding for evidence-based suicide prevention practices helps to ensure that limited public resources are used to the maximum benefit of communities.
'''Source:'''
[[br]] National Registry of Evidence Based Programs and Practices (NREPP) [http://www.nrepp.samhsa.gov]

Health Program Information

The Joint Commission urges all health care organizations to develop clinical environment readiness by identifying, developing, and integrating comprehensive behavioral health, primary care, and community resources to assure continuity of care for individuals at risk for suicide. Many communities and health care organizations presently do not have adequate suicide prevention resources, leading to the low detection and treatment rate of those at risk. As a result, providers who do identify patients at risk for suicide often must interrupt their workflow and disrupt their schedule for the day to find treatment and assure safety for these patients.^3^
'''Detecting suicide ideation in non-acute or acute care setting'''
1. Review each patient's personal and family medical history for suicide risk factors.
2. Screen all patients for suicide ideation, using a brief, standardized, evidence-based screening tool.
3. Review screening questionnaires before the patient leaves the appointment or is discharged.
'''Taking immediate action and safety planning'''
4. Take the following actions, using assessment results to inform the level of safety measures needed.
'''Behavioral health treatment and discharge'''
5. Establish a collaborative, ongoing, and systematic assessment and treatment process with the patient involving the patient's other providers, family and friends as appropriate.
6. To improve outcomes for at-risk patients, develop treatment and discharge plans that directly target suicidality.
'''Education and documentation'''
7. Educate all staff in patient care settings about how to identify and respond to patients with suicide ideation.
8. Document decisions regarding the care and referral of patients with suicide risk.
The Centers for Disease Control and Prevention has a technical package of policy, programs and practices aimed at preventing suicide at [https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf].
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3. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016.
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Health Status Outcomes

Suicide, by definition is fatal. Those who attempt suicide and survive may have serious injuries like broken bones, brain damage, or organ failure. Also, people who survive often have depression and other mental health problems.
Source: [https://www.cdc.gov/violenceprevention/pdf/suicide_factsheet-a.pdf] Accessed October 2, 2018.

Data Notes

Data provided by the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics (BVS)] in May 2016. Alaska Native people refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals of multiple races incorporating American Indian/Alaska Native are moved into the Alaska Native group. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class.
The definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium.

Data Sources

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services

National Vital Statistics System, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

Suicide mortality rate per 100,000 population (Age-adjusted), by sex, all Alaskans, 1990-2017

Data Notes

Data provided by the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics (BVS)] in May 2016. Rates based on fewer than 20 occurrences are statistically unreliable and should be used with caution.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services

Suicide mortality rate per 100,000 population, by age group and sex, all Alaskans, 2003-2017 (15-year average)

Data Notes

Data provided by the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics (BVS)] in May 2016. ** = Data suppressed. Rates based upon fewer than 20 occurrences are statistically unreliable and should be used with caution. Rates based upon fewer than 6 occurrences are not reported.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services

Data Notes

Data provided by the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics (BVS)] in May 2016. ** = Data suppressed. Rates based upon fewer than 20 occurrences are statistically unreliable and should be used with caution. Rates based upon fewer than 6 occurrences are not reported.
Alaska Native people refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals of multiple races incorporating American Indian/Alaska Native are moved into the Alaska Native group. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class.
The definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services

Data Notes

Data provided by the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics (BVS)] in May 2016. ** Data not available
Alaska Native people refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals of multiple races incorporating American Indian/Alaska Native are moved into the Alaska Native group. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class.
The definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services

Data Notes

Data provided by the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics (BVS)] in May 2016. ** = Data not available
Rates based on fewer than 20 occurrences are statistically unreliable and should be used with caution. Rates given for Skagway Municipality include Hoonah-Angoon census area counts and population. Rates given for Prince of Wales-Hyder census area include Ketchikan Gateway Borough counts and population.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services

References and Community Resources

'''Resources:'''
American Association of Suicidology [https://www.suicidology.org/]
Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2016 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2016.pdf].
Centers for Disease Control and Prevention Suicide Fact Sheets [https://www.cdc.gov/ViolencePrevention/suicide/]
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control - Preventing Suicide: A Technical Package of Policy, Programs, and Practices [https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf]
National Institute of Mental Health - Suicide Prevention [https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml]
Statewide Suicide Prevention Council [http://dhss.alaska.gov/suicideprevention/Pages/default.aspx]
State of Alaska Suicide Prevention Plan http://dhss.alaska.gov/SuicidePrevention/Documents/pdfs/Recasting-the-Net-Promoting-Wellness-to-Prevention-Suicide-2018-2022.pdf]
Suicide Prevention Resource Center [http://www.sprc.org/]
Substance Abuse and Mental Health Services Administration [https://www.samhsa.gov/prevention/suicide.aspx]
'''Resources for clinicians'''
Zero Suicide Toolkit [http://zerosuicide.sprc.org/toolkit], from the Suicide Prevention Resource Center and the National Action Alliance for Suicide Prevention
ED-SAFE Materials [http://emnet-usa.org/ED-SAFE/materials.htm], from the Emergency Medicine Network
Caring for Adult Patients with Suicide Risk [http://www.sprc.org/edguide] - A Consensus Guide for Emergency Departments, and Quick Guide for Clinicians [http://www.sprc.org/sites/default/files/EDGuide_quickversion.pdf], from the Suicide Prevention Resource Center
Means Matter website [https://www.hsph.harvard.edu/means-matter/], from the Harvard T.H. Chan School of Public Health
Mental Health Environment of Care Checklist [https://www.patientsafety.va.gov/professionals/onthejob/mentalhealth.asp] - For reviewing inpatient mental health units for environmental hazards, from the VA National Center for Patient Safety.
QPR Institute [https://www.qprinstitute.com/] - Suicide prevention courses and training for professionals, institutions, and the public, on site or through a self-study program.
SAFE-T Pocket Card for Clinicians [http://store.samhsa.gov/product/Suicide-Assessment-Five-Step-Evaluation-and-Triage-SAFE-T-Pocket-Card-for-Clinicians/SMA09-4432] - Five-step evaluation and triage for suicide assessment
Suicide Prevention and the Clinical Workforce: Guidelines for Training [https://theactionalliance.org/sites/default/files/guidelines.pdf] from the Clinical Workforce Preparedness Task Force of the National Action Alliance for Suicide Prevention
VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide [https://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf],

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